HomeMy WebLinkAbout23. Anti-Kickback FormANTI -KICKBACK AFFIDAVIT
STATE OF FLORIDA )
COUNTY OF%^ )
I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid
will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a
commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or
by an officer of the corporation.
By: )I Ip, �
The foregoing instrument was a knowledged before me this day of
20 by ( efi �� ": �-r r�4,::; M10 .�, [name
a i� ��I��t 4 i j'trh Na. j a�p
[type of authority], for
of person , as ��i 1- a �� � � 9T r� ,
[name of party on behalf of whom instrument was
executed].
AFFIX NOTARY STAMP HERE:
dt�YP4�
"I' DIANA MARIA FERRARA
4
Notary Public -State of Florida
Commission # HH 210965
My Commission Expires
December 26, 2025
Notary Public — State of Florida
_ '_ n,
1 C
Print or Type Commissioned Name
Personally Known OR Produced Identification% -
Type of Identification Produced
DECEMBER 28, 2010
ANTI -KICKBACK
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City of Sunny Isles Beach
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18070 Collins Avenue
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Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
ANTI -KICKBACK AFFIDAVIT
STATE OF FLORIDA )
COUNTY OF%^ )
I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid
will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a
commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or
by an officer of the corporation.
By: )I Ip, �
The foregoing instrument was a knowledged before me this day of
20 by ( efi �� ": �-r r�4,::; M10 .�, [name
a i� ��I��t 4 i j'trh Na. j a�p
[type of authority], for
of person , as ��i 1- a �� � � 9T r� ,
[name of party on behalf of whom instrument was
executed].
AFFIX NOTARY STAMP HERE:
dt�YP4�
"I' DIANA MARIA FERRARA
4
Notary Public -State of Florida
Commission # HH 210965
My Commission Expires
December 26, 2025
Notary Public — State of Florida
_ '_ n,
1 C
Print or Type Commissioned Name
Personally Known OR Produced Identification% -
Type of Identification Produced
DECEMBER 28, 2010